Compliance Auditor

The Compliance Auditor is responsible for planning and executing internal audits, and provides support to external audits. This position will evaluate operating and regulatory guidelines, policies and procedures, and reports negative results to management. As needed, the Auditor will utilize various databases, and spreadsheets to manage the audit process.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assist Compliance Manager in accessing Medicare program guidelines.
• Evaluate process, policy, to ensure compliance with regulatory guidelines.
• Act as an internal resource and subject matter expert on Medicare guidelines, providing regulatory guidance and interpretation to business owners to ensure ongoing compliance and consistency.
• Perform internal compliance audits on operational departments to ensure compliance with business practices and regulatory guidelines.
• Monitor calls for compliance
• Develop internal reports, action or corrective action plans
• Prepare and participate in internal/external compliance audits.
• Participate in regular meetings with business owners.
• Review reports or other documents to identify issues and trends.
• Participate in the development of any applicable compliance training, education or communication
• Review training, education and communications developed by other departments from compliance prospective.
• Maintain a working knowledge of relevant issues, laws and regulations.
• Participate in ongoing education and training.
• Perform regulatory research related to company operations
• Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.
• Conform with and abide by all regulations, policies, work procedures and instructions.

 

EDUCATION AND EXPERIENCE

• Bachelor’s degree preferred from an accredited college or university
• Minimum of one (1) year experience in health care (Medicare Programs), insurance, compliance, regulatory or law, with experience in legal research of regulatory issues and performing audits to measure compliance with regulations or any equivalent combination of related training and experience.
• Experience in billing and enrollment also desired.

 

Qualifications

WHO WE ARE

 

Convey Health Solutions manages a myriad of administrative needs and make it easier for health plans to operate and provide valuable experiences for their members. How so? We focus on building specific technologies and services that uniquely meet the needs of government-sponsored health plans.

 

OUR MISSION

To improve health plan operations and elevate the customer experience.

 

OUR VISION

Empowering health plans to excel through technology, service and advisory experience.

 

OUR VALUES

Integrity First - Inspired Teamwork - Compliance Matters